AUTHORITY OF THE FREEPORT AREA OF BATAAN

APARTMENT/DORMITORY CENSUS FORM

Personal Information Dormitory/Apartment Unit Information
Lessee Name (Last, First, & Middle Name) Sex o Male o Female Age Building Name Unit Number
Civil Status o Married o Single o Living Common Law
(check one) o Separated o Divorced o Widowed
Provincial Address AFAB Employer/Company Contact Details (telephone/email) Rental Amount Length of Stay (years & months)

Number Block, Street Barangay Municipality Province

Contact Person in Province (Last, First, & Middle Name) Contact Person Contact Details (telephone/email) Remarks

Occupant Information (attached additional sheet if necessary)

Name Age Sex Civil Status Relation to Lessee Company/Employer/School Position Net Income Date of Occupancy Religious Affiliation

Remarks (to be filled by the inteviewer)

Certification
New Award AFAB Official Reciept Number I certify that the information stated above are true and correct to the best of Interviewed by Noted by
my knowledge.
Contract Effectivity Date One Month Advance

Notarial Date Two Months Deposit DONIA G. ALONZO

Signature of Lessee Name, Signature, Designation & Date Division Manager A, CSD/FRD
CSD-FRD-FM-008 rev 000 - Census Form